## TRANSMITTA LO FOMAH A LEA D SIT E PAIN T STABILIZATIO NFIL EFOLDE R SAID#: _3i^3M_7

_Date : Address : 3 < ^ 1 % ^ 1> S SV ' LB PStabilizatio n Contractor : PRUDEN T TECHNOLOGIES , INC . Year : 200 9 PAIN T STABILIZATIO N PROPERT Y FIL EFOLDE RDOCUMENT S y ^ Vide o o f propert y (DVD) : Pre-Stabilizatio n & Post-Stabilizatio n Video s A Executiv e Summar y A Signe dAcces s Agreemen t For m A Advanc e Notic e For m A Pre-Stabilizatio n Vide o Agreemen t For m A Acces s Trackin g For m A Propert y Acces s Assessmen t For m A Neighbo r Acces s Agreemen t For m A Pain t Matc hFor m y Pre-Stabilizatio n Propert y Safety Assessmen t For m A Work-Sit e Hazard s Analysi s Checklis t y Photographs : Pre-Stabilizatio n Propert v Hazar dAssessmen t Photograph s y Dougla s Count y Assesso r Propert y informatio n y Propert y Completio n Agreemen t For mSigne db y Propert y Owne r Propert y Close-Ou t Chec k Lis t Signe dB y EP A 

# y^A^y^^^ ^ ^^_ Pruden t Technologies , Inc . Signatur e Dat e EP A Signatur e Date "

3005532 3 

# i Superfun d.INC . 

# Propert y Summar y Date : 12/-/200 9 LB PSTABILIZATIO NEP A CONTRAC T EP-R7-08-0 7 Mont hof: De c Propert y Address : 392 3 N2 5 St . SAI D # : 3334 7 A . Executiv e Summarv : a . Issue s Encountered : NON E b . Issue s Resolved : NON E c . Uniqu e Findings : NON E d . Othe r Relevan t Information : i . Acces s Date : 10/13/200 9 ii . Wor k Began : 10/30/200 9 iii . Close-Ou t Date : 11/07/200 9 B . Enclosures : 1 . Pre-Stabilizatio n Vide o 2 . Post-Stabilizatio n Vide o 3 . Signe dAcces s Agreemen t For m 4 . Advance-Notic e For m 5 . Pre-Stabilizatio nVide o Agreemen t For m 6 . Acces s Trackin g For m 7 . Propert y Acces s Assessmen t For m 8 . Neighbo r Acces s Agreemen t For m 9 . Propert y Pain t Matc hFor m 10 . Pre-Stabilizatio n Propert y Safety Assessmen t For m 11 . Work-Sit e Hazard s Analysi s Checklis t 12 . Pre - Stabilizatio n Propert y Hazar dAssessmen t Photograph s 13 . Dougla s Count y Assesso r Propert y Informatio n 14 . Signe dPropert y Completio nAgreemen t For m 15 . Propert y Close-Ou t Chec k Lis t Signe dB y EP ATBOINaLOCIBS , IN C Pruden t Technologies , Inc . (Prudent )is unde r contract (Contract #EP-R7-08-07 ) wit hthe U.S. Environmenta l Protection Agenc y (EPA ) to stabjlize Lea dBase dPain t (LBP),ate numbe r of propertie s located inOmaha, Nebraska , including the propert v located at y 7^, ^ N^f ^ <" > T ' Th e EP A requests you r permission to allow Pruden t to perfor mLB PStabilization at thi s property .By signing thi s form, the propert y owne r grants permission to Pruden t to perfor mactivitie s related to LB PStabilization including scraping pain t an d painting ofth e referencedproperty . Further, th e owner/tenan t verifie s tha t the y have receivedthe LB Ppamphle t "Renovat e Right. " By signing thi s documen t I agree to allow an EP A contracto r to conduct asoil cleanu p

at

my propert y followin g completion of lead-basedpain t stabilization ,if the soil cleanu p has not akead y bee n performed . I understandtha t the stabilization contracto r canno t provid e assurance s of whic hcontracto r wil l be boun d

to the soil cleanup . I fiirtfae r understandtha t the soil cleanu p contracto r wil l mak e all reasonable effort sto addres s concems tha t I, as the propert y owner, ma y have regarding soil cleanu p

at

my property . [ {y^s , I hav hav ee rearea dd

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above . i Signatur e ofTropert y Owne r r- ^ 

# ^0-/3 - 09 Dat e Ifyou have an y question s abou t the LB Pstabilization plannedfo r you r property , pleas e contact Prudent' s Custome r Relations/Office Manage r fo r the Lea dBase dPain t Stabilization , Mrs . Shanno n Holt , at (402) 504-100 4 or (402^812-0223 . Genera l question s abou t the OmahaLea dSit e cleanu p ca n

be directed to the EP A Public Informatio n Centersat (402 ) 73 1 ­ 3045 (Sout hOmah aoffice )or (402 ) 99 1 -958 3 (Nort hOmah aofRce) . Propert y Acces s GrantedBy ; topert y Acces s urante auy : » t (Pleas e Prin t Name) Propert y Owne r Signature : ' •/Q^ttrlat^lr<. ^ '(Signature ) 

# //-:> - / s d) ? (Date)

808 0 War d Parkway , Suit e 40 5 250 5 N. 24* ^ Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , MO 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone:(816)363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax:(210)579-657 7• TBCHNOLOGIBS , INC; ~ PROPERT YINFORMATIO N (T o b e complete d b yresiden t and/o rpropert yowne r— pleas e print ) RESIOENTNAME : iV)iCHt.Ll c)4 " ft. L L wne r/ Rente r RESIDEN TADDRESS : 

# ^1^. ^ ^ %-i ­ 

# m I F RENTAL , PROPERTYOWNE D BY : OWNER' S MAILIN G ADDRESS ; OWNER' S TELEPHON E NUMBE R - HOME : ( U/f^ ^

^OS- * I ^ZQoRK : (^<C L 9 IA' ^

t i i J i f NUMBE R O F OCCUPANT S UNDE R 7 YEAR S OLD : ^L ^ NUMBE R O F OCCUPANT S 7 YEAR S OL D AN D OLDER : NUMBE R O F CHILDRE N UNDE R 7 YEAR S OL D WHO M PLA YI N TH E YAR D FO R 5 HOUR S O R MOR E PE R WEEK :



# A . COMMENT S O R SPECIA L INSTRUCTIONS : (I.E . DOGS , ENTR YGATES , ETC. )

AUTHORITY FO RENVIRONMENTA LRESPONS EACTIONS : Tli e activitie s t o b e implemente db y EPA unde r thi s agreemen t ar e pursuan t t o Sectio n 10 4 ofCERCLA , 4 2 U.S.C . 9604 . EPA' s righ t o f acces s t o th e property i s provide dfor in Sectio n 104(e ) ofCERCLA , 4 2 U.S . C 9605(e) , whic hprovide s entry fo r "determinin g th e nee dfor response , o r choosin g o r takin g any respons e actio nunde r thi s title , o r otherwis e enforcin g th e provision s ofth e title. "

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7TECHNOLOGIES , INC . 

# Advance dnotic e needed . Afte r

signin g th e acces s you allo w Pruden t t o begi n Lea dBase d Pain t Stabilization . Al l Plants , weed s an dan y vehicle s o r item s on open porc h(enclose dporche s wil l NO T b e stabilized ) mus t b e remove dprio r t o stabilization . All Pet s mus t b e ou t o f

yar ddurin g stabilization . Ho w muc hnotic e d o you nee dt o hav e abov e mentione dtask s completed ? Ifyo u ar e alandlor dyou wil l nee dt o contac t th e tenan t a s Pruden t Technologie s wil l only informyou . Do you hav e an y pet s tha t resid e i nyard ? | V ^ Notic e neede d 

# : A-n/ ; ^» ' IV l c Numbe r t o cal l t o giv e notice : S' O A^ I o e> c O Who mw e ar e givin g notic e to : ( ^ r ^ I V I ^ y ' ^ ^ Home Owner' s Signatur e

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816)363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7TECHNOLOGIES. ] 

## PRE-STABILIZATIO N VIDE O FORM I UNDERSTAN D THA T PRUDENT TECHNOLOGIE S WIL LB ECOMIN G OUT T O SHOO T A PRE-STABILIZATIO N VIDE O AT MY PROPERTY . TH EVIDE O I S JUS T A TOO LUSE D T O DOCUMENT TH ECURREN T PROPERT Y STATUS/CONDITION . A POS T VIDE O WIL LALS O B E SHO T PRIO RT O COMPLETIO N O FSTABILIZATION . 

# Je.SS>€ . W Q OWNER S NAME : PROPERT Y ADDRESS : 3><^22 > ^ ^ '2. 6 ^ 

# 333M1 - BVID/SAID 

# : HOMEOWNER S SIGNATUR E 

# •.^-^4t^4j^ h'i y PRUDENT REPRESENTATIV ESIGNATURE : 

# cyH r AN Y CONDITION S NEED T O B EAWAR EO FBEFOR ESHOOTIN G VIDEO : (I.E . PETS , NOTIC ENEEDED) : 

# • /jt^^h^ ^

808 0 War d Parkway , Suit e 40 5 250 5 N . 24* " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7TECHNOLOGIES, ] 

# ACCES S INFORMATIO NTRACKIN GSHEE T BVI D 

# : ^^3^ 7 PROPERT Y ADDRES S 

# : 3q2 S ^ 2^-^- ^ Propert y Owne dBy : (I f ne w propert y owner )

Owner s Phon e No's : Home : Work : Cell : ~ Fax : ~ Acces s Contractor : AS WPD A ME S P EOthe r (Prudent ) DAT E TIM E ACCESSO R CONRAC T DETAI L 

# fe>lf%)/ ^ 

# /// h iU^iM ^ aA.a4^%4''<^ ' / ' f ' 

# I I 

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## Comments :

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone:(816)363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7TECHNOLOGIES . INC . 

# Acces s Assessment Form : (Mus t b e complete dfor ever y property . Informatio nmus t b e obtaine dfro mapropert y wal k thru , no t given b y owner ) I s th e propert y stucc o o r asbestos ? I f

yes , i s an y ofth e stucc o o r asbesto s damage do r cracked ? I f

yes , sto p a s w e can' t stabiliz e thi s property . I t require s specia l preparatio n techniques . I t wil l b e returne dt o EP A an dthe y wil l assig na t alate r date . Doe s thi s propert y requir e lot s o f scrapping ? Doe s thi s propert y requir e alif t o r scaffoldin g t o reac huppe r levels ? Doe s thi s propert y hav e lot s o f plant s o r item s i narea s wher e paintin g i s required ? A- ^ Doe s thi s propert y hav e an y significan t structura l damage ? I f

yes , EXPLAIN ?

808 0 War d Parkway , Suit e 40 5 250 5 N . 24* " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , T X 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7TECHNOLOGIES , INC . 

## Doe s thi s propert y hav e agarage ? I f

yes , describ e locatio no f garage . Doe s thi s propert y hav e aluminu msiding ? I f

yes , i s i t origina l factor y finis ho r ha s i t bee npainte dover ? Doe s thi s propert y hav e an y othe r typ e o f structura l components ? (I.e . roo f shingle s a s siding) ? I f

yes , EXPLAIN ? I s thi s propert y vacan t o f occupied ? Ar e ther e an y pet s a t thi s property ? /-\A ^ Ar e ther e an y lo w hangin g powe r lines ?

808 0 War d Parkway , Suit e 40 5 250 5 N . 24* " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7OOLOGIES . INC . 

### PAIN T MATCHIN GFORM : 1 . T O B EFILLE D OUT ONL Y I FMATCHIN GCOLO R PROPERT Y ADDRESS : gt^^b < ^ O^ S S f BVID : 2>2)^M > Th e following note s ar e for th e benefit o f

pain t crew only . Pain t Ye s Pain t N o Locatio n Pain t Descriptio n Sidin g / Soffit 

# A ? Fasci a 

## C K 

# 1 Come r Tri m ^ ^ Windo w Trim s Door Trim s / Front Porc hCeilin g 

# ^^S ' / Front PorchCeilin g Beam s 

# 1 J Front Porc hFloo r Front PorchRailing s \ ^ Front PorchStep s 

# 1 ^ Sidin g Baseboard s Foundatio n

1



### • I UNDERSTAN D SHERWI N WILLIAM S WIL LMATC H M Y CURREN T COLORS . Homeowner signature ; 

# •.^MiJeu U k ^ D..e:/^-;.3-d f

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street . Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7TECHNOLOGIES , IN C 

## NEIGHBORHOO D PROPERT Y ACCES S FOR M I S THER EA NEIGHBORIN GPROPERT Y THA T NEED S T O B EACCESSED ALON G WIT H ASSIGNED PROPERT Y T O COMPLET ESTABILIZATIO N PROCESS ? 

## tsj O I FI T IS , GE T ACCES S FRO M AL LREQUIRE D NEIGHBORHOO D PROPERTIES . 

# 1^ 0

808 0 War d Parkway , Suit e 40 5 250 5 N . 24' " Street , Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax:(210)579-657 7TECHNOLOGIES, ] 

### PRE-STABILIZATIO N PROPERT Y SAFET Y ASSESSMEN T FOR M PROPERT Y ADDRESS : 3 ^ 2 ? > f ^ 2- S S T* BVID/SAID : Q>3>S^ ^ PRUDENT ASSESSMENT REPERSENTATIVE : 

# l^a^ J 4^f^ - REPERSENTATIV EREMARKS/FINDINGS : (POWER-LINEPROXIMIT Y T O PROPERTY , SCAFFOLDING / LADDERS / LIFT S NEEDED , UNSAF EAREAS , UNSAF ENEIGHBORHOOD...ETC. )

808 0 War d Parkway , Suit e 40 5 250 5 N . 24* " Street , Suit e 30 8 424 2 Medica l Drive , Suit s 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone:(816)363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7

# Curren t Sampl e Pre-Renovatio n For m Effectiv e unti l Apri l 2010 . Confirmatio n o f Receip t o f Lea d Pamphle t a r1 hav e receivec i a copyo f th e pamphlet . Renovate Right : Importan t Lea d Hazar d Informatio n fo rFamilies , Chil d Car e Provider s an d School s informin g m e o f th e potentia l ris k of th e lead hazar d exposur e fro m renovatio n activit yt o b e performe d i n m ydwellin g unit . I receive d thi s pamphlet befor e th e wor k began . 

# ^.Vh-el U j Q i^y/o-j>-c> l Printe d nam e o f recipien t ^ ^

0 / Dat e Signatur e of recipien t Self-Certificatio n Optio n (fo rtenant-occupie d dwelling s only ) — I f th e lead pamphlet was delivere d bu t a tenan t signatur e was not obtainable , yo u ma ychec k th e appropriat e boxbelow . •Refusa l t o sig n —I certif ythat I hav e mad e a goo d fait h effor t t o delive rth e pamphlet , Renovate Right : Importan t Lea d Hazar d Informatio n fo rFamilies , Chil d Car e Provider s an d Schools , t o th e renta l dwellin g uni t liste d belo wa t th e dat e an d tim e indicate d an d that th e occupan t refuse d t o sig n th e confirmatio n of receipt . I furthe rcertif ythat I hav e lef t a copyof th e pamphlet a t th e uni t wit h th e occupant . QKfnavallabl e fo rsignatur e — I certif ythat I hav e mad e a goo d fait h effor t t o delive rth e pamphlet , Renovate Right : Importan t Lea d Hazar d Informatio n fo r Families , Chil d Car e provider s an d Schools , t o th e renta l dwellin g uni t liste d belowan d tha t th e occupan t wa s unavailabl e t o sig n th e confirmatio n of receipt . I furthe rcertif ythat I hav e lef t a copyof th e pamphlet a t th e uni t b yslidin g i t unde rth e door . / / /

> i Printe d nam e o f perso n certifying f ^ Attempte d deliver y dat e an d tim e lead pamphlet deliver y Signatur e of perso n certifyin g lead pamphlet deliver y

Uni t Addres s Not e Regardin g Mailin g Optio n — As a n alternative t o deliver yi n person , yo u ma ymai l th e lead pamphlet t o th e owne rand/o rtenant . Pamphlet must b e maile d a

t leas t 7 day s befor e renovatio n (Documen t wit h a certificat e o f mailin g fro m th e post office) .

### --- 

## Checklist for the Worksite Hazard Analysis 

# a59% Address: Crew: Date:

Levels around high wires 

# -

-- I 

### Vehicle Clearance around 1

. 

### General Condition 6. J,,u 

# , ,,

Damaged Areas: sink holestrotted wood Insects P 

### nditions ing conditions 

# -

a 

## .. Crew Fnremanl Sub- 

# , Site Safety Officer 180%ard Parkway. ansas City. MO 64'~ 

### ,.+ Fax: (402) 504-1005

# - w• 

# lil t/ 

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; • ' -^>:.i^:::H: ^ V - = <•- •

f - •*-.-^" ' TT^^^^ iDougla s Count y Account Informatio n http://douglasne.niaRBJng-online.com/DouglasCoNe/static/accountinfo.. , laDDi n Dougla s County , Nebrask a Properl YRecor d - R184044000 0 Prin t Repor t NE

W Featur e - Parce l Dimension s availabl e @ scal e 0-50 f t wes t o

f 52n d S t - VlC W O n Ma p Informatio n i s vali d a s o f 2009-9-2 9 Treasurer' s Ta xRepor t Ne wFeatur e • * r ¥^ Aut o Sale s Searc h Owne r HAL L JESSI E R ETA L 392 3 N 2 5 S T OMAH AN E 68111-000 0 

# 333^ 7 Propert yInformatio n Ke yNumtie r Accoun t Type : 

### Parce l Numtie r 404 4 000 0 1 8 Residentia l 184044000 0 Parce l Address : 392 3 N 2 5 S T OMAH AN E 68111-000 0 Lega l Description : N O RR I S SU B DI V LO T6 BLOC K0 4 2 X 10 0 Valu e Informatio n 200 9 Lan d $2,200.0 0 Improvemen t $15,500.0 0 Tota l $17,700.0 0 200 8 200 7 200 6 200 5 200 4 $2,200.0 0 $2,200.0 0 $2,200.0 0 $2,200.0 0 $2,200.0 0 $15,500.0 0 $15,500.0 0 $15,500.0 0 $6,800.0 0 $6,200.0 0 $17,700.0 0 $17,700.0 0 $17,700.0 0 $9,000.0 0 $8,400.0 0 Lan d Informatio n Acre s 0.0 9 S F 4200. 0 Unit s 1. 0 Dept h 100. 0 Widt h 42. 0 Vacan t N o Improvemen t Informatio n Buildin g 1

lo f 2 10/9/200 9 9:2 9 A MDougla s Count y Account Infonnatio n http://douglasne.maDDing-online.coin/DouglasCoNe/static/accountinfo. . laoDi n

3a23N D 2MSI .

MS T 11 V 

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### r • 0 w r avfMot rl, r

"** * —I BantBUdia t x i t 11/ 2 9lgry CLIC KTO ENLARG E IMAG E CLIC KT O ENLARG E IMAG E Squar e Footage : 1248. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Fai r Uni t Type : Condition : Poo r

Buil t As : 1 1/ 2 Stor yFi n Cond o Squar e Footage : 0. 0 HVAC : Force d Ai r Rooms : 7. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : Plaste r Baths : 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 4. 0

Roo f Type : Gabl e Stories : 1. 5 Floorcover : Allowanc e Foundation : Sprinkle rSquar e Footage : 0. 0 Yea r Percen t Adjuste d Yea r Yea rBuii t Physica l Ag e Remodele d Remodele d Buii t 191 0 0 0 % 191 0 9 9 Deta/7 Typ e Defa/7 Descriptio n Unit s Applianc e Allowanc e 1. 0 Basemen t Bsmn t Bloc k 8 f t 856. 0 Fixtur e Bas e Fixture s 1. 0 Fixtur e Bat h Ful l 1. 0 Porc h Cvrd Woo d Dec k 153. 0 Use r Atti cFul l Finis h 392. 0 Use r Sourc e # 2. 0

2 o f 2 10/9/200 9 9:2 9 A MVXLOCJBS.JNC . 

### Pruden t Propert yClose-Ou t For m (Lead-Base d Pain t Stabilization ) SAID : s2>2?'b'y j

—/k "

—^ I Propert yAddress : 3^^ ^

^ «^ ^

-^ ' Owner' s Name : M/'CW^'e ^ l-f^tl l S.N O Performanc e Standards/close-Ou t Criteri a Ye s N O Wa s th e entir e structure(s ) painte d wit h th e exceptio n o f th e stated , exclude d areas ? Thi s woul d includ e paintin g o f othe rassociate d feature s includin g fascia , eaves , siding , al i trim , porches , bo x beams , columns , rails , an d exterio rsurface s o f garages . Wa s al l scrapin g an d othe rpreparatio n wor k complete d satisfactorily ? Wer e al l require d area s o f th e structure(s ) prime d a s neede d an d painte d wit h tw o to p coats ? 

# y Ar e al l ofth e area s wher e contaminate d material s hav e bee n spille d thoroughl yvacuumed / cleaned ? Di d th e contracto rcollect/vacuu m al l fallin g an d scrape d pain t chip s o n th e entir e property , roadways , alleyways , publi cacces s area s an d als o remov e an yothe rgenerate d debris ? I s th e gras s are a tha t surround s th e structure(s ) i n reasonabl ygoo d 

# V condition ? Wa s th e pain t product s utilize d equivalen t t o a 3 0 yea r 

# V product/quality ? Ar e al l item s suc h a s polyethylen e sheeting , ladders , pain t brushes , cones , barrie rtap e et cproperi yremoved ? 

# V I s ther e an yevidenc e o f propert ydamag e tha t wa s don e b yth e contractor ? An ypropert ydamag e need s t o b e complete d prio rt o th e EP AClose-Out . 1 0 Ar e ther e an ypropert yitem s tha t wer e temporaril yre-locate d b yth e contracto rtha t nee d t o b e move d back ? 1 1 Ar e ther e an y(known ) lingerin g issue s wit h th e propert yowner(s ) tha t hav e bee n lef t unresolved ? 

# y 1 2 othe rConsiderations ? Propert yOwne rDiscussions ? Additiona l Wor k tha t i s Require d Pruden t Representativ e Signatur e 

### Date:\\0-'C ^ Propert yOwne rSignature : 

### Date : \y n ^ 808 0 War d Parkway , Suit e 40 5 250 5 N . n rstreet . Suit e 30 8 424 2 Medica l Drive , Suit e 425 0 Kansa s City , M O 6411 4 Omaha , Nebrask a 6811 0 Sa n Antonio , TX 7822 9 Phone : (816 ) 363-370 3 Phone : (402)504-100 4 Phone : (210)822-958 8 Fax : (816 ) 363-370 7 Fax : (402)504-100 5 Fax : (210 ) 579-657 7